CT in the Emergency Room

Replies to This Discussion

Permalink Reply by Stephen Hite on February 12, 2009 at 3:47pm

Hi Erik

Our scanner is in the hall directly across from the ER, don't know if that counts. What is the setup you are experiencing? Are the ER physicians reading the scans? Please check out my earlier post regarding contrast.

I know of a local hospital here that does incorporate the scanner into the ER.

Thanks

Steve

• ▶ Reply

Permalink Reply by Erik Ranschaert on February 12, 2009 at 4:32pm

our clinicians want a setup in which the CT is in the ER, to facilitate access (trauma patients, TIA's etc). Radiologists will have to read the scans (except for the brain scans, neurologists do that in the ER).
If someone has experience with this setup I'd like to hear that. We think that the scanner will be used inefficiently (idle time is expected to be high we think). Will this disadvantage outweigh the advantages of having the CT in the ER?

• ▶ Reply

Permalink Reply by Erin Tate on February 17, 2009 at 10:12am

I work in a level one trauma center and we have a scanner in the emergency room that is never sitting idle. I suppose the size of your facility and the nature of the injuries that are treated would impact how often the scanner is used. In our trauma cases the scanner is used to clear the c-spine so 99% of all trauma cases get some form of CT scan. There is also a high enough volume of medicine patients needing scans that their is sometimes a backlog. We have 4 other scanners that are used for the house patients. What type of facility are you working in?

• ▶ Reply

Permalink Reply by Erik Ranschaert on February 17, 2009 at 10:41am

I work in a teaching hospital which is still in 2 different locations but in 2010 we'll have a new hospital in which the ER is currently being built. For the moment we have 2 64-slice MDCT's and one 16slice PET-CT. We need an additional CT scanner at the dpt to cope with the increasing demand for CT. We don't use your classification for ER's but we have all kinds of trauma except heavy neuro-trauma. Can you still call it a level one if there's no neurosurgery?

• ▶ Reply

Permalink Reply by Erin Tate on February 17, 2009 at 12:34pm

No - I believe that is part of the criteria. The hospital I work in is also a teaching hospital as well as the county hospital. A new facility is also being built and expected to be completed in 2014 - radiology will be all digital; currently we are a mixture of CR and DR. All of the trauma plain films are shot with portable machines - there are no dedicated tubes in the trauma bays.

At our facility the radiologists have a short time limit to get trauma films read after we complete the exam and for us the timer starts when an exam is ordered - has there ever been an issue of not having a scanner available for a trauma patient when they were cleared for scan?

• ▶ Reply

Permalink Reply by Erik Ranschaert on February 17, 2009 at 1:59pm

No, not at all. We have emergency slots in our scanning programme, and in the new hospital the scanner rad dpt wil only be 1 floor away. Reading time is no problem: we are almost fully digital, we have residents with on-call services and radiologist can access the images immediately from their homes during calls. We have monitored the access times for CVA patients (thrombolysis) and the single time we had a delay it was because of a technical problem. Our clinicians are convinced for one reason or the other that having a CT in the ER is an absolute prerequisite in a modern hospital, and have been putting pressure on the hospital management - radiologists have hardly been involved in the discussion until now. So I'm interested to know from colleagues who are used to work with this kind of setting what they think about it and if it really offers an added value other than having the scanner almost next to the patient. For example: how about the increase of unnecessary scans? Recently an article was published about the dramatic increase of irradiation in adolescents due to CT scanning in the ER.

• ▶ Reply

Permalink Reply by Erin Tate on February 17, 2009 at 2:19pm

I absolutely agree about the increase of unnecessary exams - I sometimes think that the ordering doctors forget that their patients are being exposed to radiation. The only benefit that I can think of is that it keeps the patients in the emergency department - they dont have to be transported far, it is less time on the portable monitors, and if the patient did crash the emergency staff is literally right there. In our hospital the trauma nurses transport the trauma cases to the scanner and if the patient is questionably stable the doctor attends the scans also. So in our case having the scanner in the ER keeps key personnel in the department and eliminates the need for staff available to transport non-trauma cases to a scanner in a different area. Mainly I think it is just convenient - there have been times when that scanner has been down and we have managed just fine; however our other scanners are just outside the emergency department. Sorry I can't speak from a radiologists viewpoint...

• ▶ Reply